Test Bank For Gerontologic Nursing 5th Edition by Sue E. Meiner

$35.00
Test Bank For Gerontologic Nursing 5th Edition by Sue E. Meiner

Test Bank For Gerontologic Nursing 5th Edition by Sue E. Meiner

$35.00
Test Bank For Gerontologic Nursing 5th Edition by Sue E. Meiner

Test Bank For Gerontologic Nursing 5th Edition by Sue E. Meiner

GERONTOLOGIC NURSING 5TH EDITION BY SUE E. MEINER – TEST BANK

Chapter 02: Theories of Aging

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

  1. The practitioner who believes in the free radical theory of aging is likely to recommend that the older adult:
a.avoid excessive intake of zinc or magnesium.
b.supplement his or her diet with vitamins C and E.
c.increase intake of complex carbohydrates.
d.avoid the use of alcohol or tobacco.

ANS: B

Vitamins C and E are two naturally occurring antioxidants that appear to inhibit the functioning of the free radicals or possibly decrease their production in the body. The free radical theory of aging is not related to zinc, magnesium, carbohydrates, or alcohol and tobacco.

DIF: Applying (Application) REF: N/A OBJ: 2-2

TOP: Nursing Process: Planning MSC: Health Promotion

  1. To provide effective care to the older adult, the nurse must understand that:
a.older adults are not a homogeneous sociologic group.
b.little variation exists in cohort groups of older adults.
c.health problems are much the same for similar age groups of older adults.
d.withdrawal by an older adult is a normal physiologic response to aging.

ANS: A

The key societal issue addressed by the age stratification theory is the concept of interdependence between the aging person and society at large. This theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process. The theory attempts to explain the interdependence between older adults and society and how they constantly influence each other in a variety of ways. Variation exists among the members of a cohort. Health problems are not the same for every individual of the same age. Withdrawal by an older adult is not a normal response to aging but may be a sign of depression.

DIF: Understanding (Comprehension) REF: Page 16 OBJ: 2-2

TOP: Nursing Process: Planning MSC: Health Promotion and Maintenance

  1. The nurse is using the eight stages of life theory to help an older adult patient assess the developmental stage of personal ego differentiation. The nurse does this by assisting the patient to:
a.determine feelings regarding the effects of aging on the physical being.
b.describe feelings regarding what he or she expects the future to hold.
c.identify aspects of work, recreation, and family life that provide a sense of self-worth and pleasure.
d.elaborate on feelings about the prospect of his or her personal death.

ANS: C

During the stage of ego differentiation versus work role preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. The onset of retirement and termination of the work role may reduce feelings of self-worth. In contrast, a person with a well-differentiated ego, who is defined by many dimensions, can replace the work role as the major defining source for self-esteem. Determining feelings related to the effects of aging, future death, or what the future may hold is not part of this theory.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

  1. A patient is recovering from a mild cerebral vascular accident (stroke). The home care nurse notes that the patient is talking about updating a will and planning funeral arrangements. Which of the following responses is most appropriate for the nurse to make?
a.“You seem to be preoccupied with dying.”
b.“Is there anything I can do to help you?”
c.“Are you worried about dying before you get your affairs in order?”
d.“Let’s focus on how you are recovering rather than on your dying.”

ANS: B

According to Peck’s expansion of Erikson’s theory, the older adult who has successfully achieved ego integrity and ego transcendence accepts death with a sense of satisfaction regarding the life led and without dwelling on its inevitability. The patient’s action reflects a healthy transition and should be supported.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

  1. Your patient’s spouse died recently from a sudden illness after 45 years of marriage. The patient was the primary caregiver for the spouse during this time. The patient is now depressed and withdrawn and has verbalized feelings of uselessness. Which action by the nurse is best?
a.Encourage the patient take up a hobby that will occupy some time.
b.Explain that volunteering would be an excellent way to stay useful.
c.Assure the patient that these feelings of sadness will pass with time.
d.Ask the patient to share some cherished memories of the spouse.

ANS: B

Volunteering will help the patient to interact with people and feel productive and valued for the ability to help others as stated in the activity theory. A hobby does not offer the chance to help others. Assuring the patient that feelings will pass is false reassurance and does nothing to help the patient to be proactive. Reminiscing is a valued activity, but it is not the best choice for regaining a sense of usefulness.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

  1. A patient has recently been diagnosed with end-stage renal disease. The patient has cried often throughout the day and finally confides in the nurse that “I am going home to be with my Lord.” The nurse’s best response is:
a.“There is no reason to believe the end is near.”
b.“Do you want me to call your family?”
c.“We have a wonderful chaplain if you’d like me to call him.”
d.“I think this is the time for us to pray together.”

ANS: C

It is important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth while addressing spirituality as a component in holistic care without imposing upon the patient. Because the patient has made reference to the Lord, the nurse can safely offer religion-oriented spiritual care. Telling the patient there is no reason to believe that death is near does not help the patient work through emotions. Asking about calling the family is a yes/no question and is not therapeutic. The nurse is assuming too much by saying it is time to pray.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

  1. A nurse is responsible for the care of 20 older adults in a unit of an assisted living facility. In order to best address the needs and wants of the entire unit’s population, the nurse:
a.strictly adheres to facility policies so that all patients will be treated equally.
b.encourages specific age cohorts to gather in the dayroom because they share similar interests.
c.has the unit vote on which television programs will be watched each evening.
d.schedules the patients’ bathing times according to their individual preferences.

ANS: D

Older adults continue to feel valued and viewed as active members of society when allowed to maintain a sense of control over their living environment by attention to personal choices and rituals. Adhering strictly to policies does not allow for individualized care. Not all in the same age cohort will have similar interests. Voting on television programs does not ensure each individual feels a sense of worth.

DIF: Applying (Application) REF: N/A OBJ: 2-5

TOP: Nursing Process: Planning MSC: Psychosocial Integrity

  1. An older patient who reports being “healthy enough to cut my own fire wood” is being assessed prior to outpatient surgery. The nurse recognizes which assessment observation as a possible result of the wear-and-tear theory?
a.Swollen finger joints
b.Red, watery eyes
c.Grimacing when raising left arm
d.Bilaterally bruising on the forearms

ANS: C

This theory proposes that cells wear out over time because of continued use. The pain caused by movement of the shoulder is the observation most likely a result of the patient’s practice of cutting his own firewood. The other choices do not demonstrate continued use that is part of the wear-and-tear theory of aging.

DIF: Applying (Application) REF: N/A OBJ: 2-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. A nurse cares for many older patients. Which finding should the nurse identify as pathologic in a 72-year-old?
a.Two hospitalizations in 6 months for respiratory infections
b.Patient reports of sleeping only of 5 to 6 hours each night
c.Thinning hair and brittle nails
d.Dry, tissue paper–like skin

ANS: A

Although there is an age-related decrease in immune function, reoccurring infections serious enough to require hospitalization are not considered a normal age-related finding. Decreased sleeping, thinning hair, brittle nails, and dry skin are all normal signs of aging.

DIF: Application (Apply) REF: N/A OBJ: 2-1

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. In planning the care for an older adult patient, the nurse will best promote health and wellness by:
a.encouraging independent living and self-care.
b.scheduling regular cardiac and respiratory health screenings.
c.effectively delivering health-related educational information.
d.promoting a nutritious diet and an age-appropriate exercise routine.

ANS: C

Providing well-prepared and effectively delivered health-related educational information will provide the best means of promoting a patient’s ability to impact his or her wellness and general health. Each of the other options is too narrow to be the most effective way to promote health and wellness.

DIF: Applying (Application) REF: N/A OBJ: 2-5

TOP: Nursing Process: Planning MSC: Health Promotion

  1. The student learning about aging theories understands that the main difference between stochastic theories and nonstochastic theories is which of the following?
a.Stochastic theories view aging as a random, cumulative process.
b.Stochastic theories view aging as similar among all people.
c.Nonstochastic theories view aging as a result of psychosocial factors.
d.Nonstochastic theories are backed by research, whereas stochastic theories are not.

ANS: A

Stochastic theories view aging as a result of random events and their cumulative effects. Nonstochastic theories view aging as a result of predetermined, timed phenomena. Both are types of biologic theories.

DIF: Remembering (Knowledge) REF: Page 17 OBJ: 2-1

TOP: Teaching-Learning MSC: Physiologic Integrity: Physiologic Adaptation

  1. Which theory of aging does the student learn is related to problems with DNA transcription?
a.Radical theory
b.Error theory
c.Cross linkage theory
d.Wear-and-tear theory

ANS: B

The error theory poses that errors in DNA transcription lead to aging. The radical theory views the effects of free radicals as critical to aging. The cross linkage theory states that normally separated molecular structures are bound together through chemical reactions and that this interferes with metabolic processes. The wear-and-tear theory postulates that normal activity causes wear and tear on the body, leading to aging.

DIF: Remembering (Knowledge) REF: Page 19 OBJ: 2-1

TOP: Teaching-Learning MSC: Physiologic Integrity: Physiologic Adaptation

  1. According to which theory does cancer occur as a possible result of aging?
a.Radical theory
b.Error theory
c.Immunity theory
d.Pacemaker theory

ANS: C

Immunosenescence is the term used in immunity theory to describe an age-related decrease in immune functioning. According to this theory, as people age, they are more prone to getting cancer or autoimmune diseases because of this phenomenon. This is a nonstochastic theory. Radical and error theories are both stochastic. The pacemaker theory looks at the interrelated role of the neurologic and endocrine systems and aging.

DIF: Remembering (Knowledge) REF: Page 19 OBJ: 2-1

TOP: Teaching-Learning MSC: Physiologic Integrity: Physiologic Adaptation

  1. A nurse assesses an older patient who has lost a great deal of weight in a short time. When asked, the patient states this behavior started after the patient read a magazine article on the benefits of extreme caloric restrictions. What response by the nurse is best?
a.“That research was done on rodents and not on humans.”
b.“You shouldn’t restrict your calories so severely.”
c.“You have lost so much weight you need dietary supplements.”
d.“You can’t believe everything you read in those magazines.”

ANS: A

The metabolic theory of aging postulates that organisms have a specific metabolic lifetime and that by lowering metabolic rate, life span can be increased. However, this has been demonstrated in rodents and the nurse should educate the patient on this information. The other options do not give information that will help the patient make an informed decision as to whether or not to follow this activity.

DIF: Applying (Application) REF: N/A OBJ: 2-1

TOP: Communication and Documentation

MSC: Physiologic Integrity: Reduction of Risk Potential

  1. A nurse is caring for an older patient who is sedentary and does not want to participate in any activities. What action by the nurse is best?
a.Inform the patient about the consequences of immobility.
b.Promote activity by explaining the “use it or lose it” concept.
c.Tell the patient he or she will feel better by being more active.
d.Explain the relationship of being active and being independent.

ANS: D

Activity increases circulation, provides range of motion, and leads to clearer mental functioning. Activity helps a person remain independent and able to perform activities of daily living (ADLs) and instrumental ADLs. Presenting information in a positive light that encourages the patient to take control of one’s own health is more likely to be successful than stressing the negative such as consequences of immobility or the concept of “use it or lose it.” Telling the patient that he or she will feel better does not give concrete information the patient can use to make decisions.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Teaching-Learning MSC: Health Promotion

  1. The nurse working with older patients teaches the student that disengagement theory potentially causes which problem?
a.Fear
b.Isolation
c.Anxiety
d.Malnutrition

ANS: B

The no-longer supported disengagement theory posed that older people withdrew from society as they aged and that this was a mutually agreed upon behavior. The result would be isolation as the person became focused solely on him- or herself. Fear, anxiety, or malnutrition could be a further consequence, but isolation and withdrawal from society was “expected” according to this theory.

DIF: Understanding (Comprehension) REF: Page 22 OBJ: 2-5

TOP: Teaching-Learning MSC: Psychosocial Integrity

  1. The nurse working in a long-term care facility used the developmental theory of aging in practice. In caring for a frail, nearly bed bound patient, how can the nurse use this theory?
a.Engage the patient in intellectually stimulating activities.
b.Encourage the patient to participate in chair exercises.
c.Ensure that the patient participates in all the group activities.
d.Give the patient small “chores” to do for the facility.

ANS: A

In this theory, being active can mean physical or intellectual activity. The nurse can engage the patient in intellectually stimulating activities that allows the person a sense of satisfaction. The other options all call for physical activity, which the patient may or may not be able to perform.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

  1. The nurse working at a long-term care facility notes that one patient who is usually outgoing refuses to participate in games that require keeping score. What action by the nurse is best?
a.Ask the patient why he or she won’t participate.
b.Assess the patient’s level of frustration with these activities.
c.Find other activities for the patient to participate in.
d.Do nothing; the patient can choose activities to engage in.

ANS: B

Although it is true that patients should be able to choose activities in which to participate, the best option is to assess the patient for frustration or anxiety associated with these types of activities. Once that is determined, the nurse can find other activities the patient can engage in successfully and is willing to participate in if the games are not an option. Asking “why” questions often puts people on the defensive and is not a therapeutic communication technique.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

  1. The nurse planning community events for older people uses sociologic theories to guide practice. Which activity planned by the nurse best fits these theories?
a.Group exercise programs
b.Volunteering at a day care
c.Healthy cooking classes
d.Reminiscing therapy

ANS: B

Using the sociologic theories to guide care, the nurse would plan events that allowed the older adult to remain active in the community and a valued member of society. Volunteering would offer the adult a way to stay engaged and provide a service to successive generations. Exercise and cooking classes would more fit in the biologic theories. Reminiscing therapy is a technique using psychological theories. All are good ideas for activities, but the one that specifically uses sociologic theory is the volunteer work.

DIF: Applying (Application) REF: N/A OBJ: 2-2

TOP: Nursing Process: Analysis MSC: Psychosocial Integrity

  1. What statement by a patient most indicates healthy aging according to Jung?
a.“I wish I had traveled more when I was younger because now I can’t.”
b.“I am proud of my past accomplishments at work and home raising my kids.”
c.“My leg amputation makes things harder, but I still find a way to work.”
d.“I still like to read the paper and novels and enjoy a little gardening.”

ANS: C

This patient shows acceptance of past accomplishments and finds value in him- or herself despite current limitations, which is healthy aging according to Jung. The person who wants to travel more displays remorse. The focus on past accomplishments does not show current acceptance. Reading and gardening do not show acceptance of past accomplishments.

DIF: Analyzing (Analysis) REF: N/A OBJ: 2-2

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

  1. A nurse is trying to teach a hospitalized older patient how to self-inject insulin. The patient is restless and does not seem to be paying attention. What action by the nurse is best?
a.Ask if the patient needs to use the bathroom.
b.Tell the patient you’ll try again later in the day.
c.Ask if the patient prefers that you teach the family.
d.Refer the patient for home health care services.

ANS: A

According to Maslow, physical needs take priority over other activities. This patient may be hungry, cold, tired, or need to use the bathroom. Telling the patient you’ll try again later, asking if you should teach the family, and referring to home health care does not provide for any unmet physical needs.

DIF: Applying (Application) REF: N/A OBJ: 2-4

TOP: Nursing Process: Implementation MSC: Physiologic Integrity: Basic Care and Comfort

  1. The new nurse at a long-term care center asks the director of nursing why he needs to learn so many theories of aging. What response by the director is best?
a.“No theories have been proven yet.”
b.“A wide range of theories allows for holistic care.”
c.“It’s required knowledge for certification exams.”
d.“All the theories are important, so we use them all.”

ANS: B

Using a combination of different theories, each with its own focus, allows the nurse to plan individualized, holistic nursing care.

DIF: Applying (Application) REF: N/A OBJ: 2-5

TOP: Communication and Documentation MSC: Psychosocial Integrity

MULTIPLE RESPONSE

  1. According to Maslow, a fully actualized person displays which traits? (Select all that apply.)
a.Spontaneity
b.Self-direction
c.Creativity
d.Ethical conduct
e.Acceptance of self

ANS: A, B, C, E

A fully actualized person displays the following characteristics: perception of reality; acceptance of self, others, and nature; spontaneity; problem-solving ability; self-direction; detachment and the desire for privacy; freshness of peak experiences; identification with other human beings; satisfying and changing relationships with other people; a democratic character structure; creativity; and a sense of values. Maslow does not specify ethical conduct.

DIF: Remembering (Knowledge) REF: Page 24 OBJ: 2-5

TOP: Teaching-Learning MSC: Psychosocial Integrity

Chapter 14: Pain

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

  1. When planning care for the older adult experiencing pain, the nurse bases interventions on the realization that:
a.generally pain control is less effective than it is for younger adults.
b.this cohort is less pain sensitive than younger adults.
c.older adults are more likely to verbally express pain than younger adults.
d.pain is undertreated in this cohort compared to younger adults.

ANS: D

Pain is underrecognized, highly prevalent, and undertreated among older adults.

DIF: Remembering (Knowledge) REF: Page 256 OBJ: 14-4

TOP: Nursing Process: Analysis MSC: Physiologic Integrity

  1. An older patient is observed grimacing whenever walking and getting in and out of bed. When assessed, the patient regularly denies having any pain. To best provide the patient with effective pain control, the nurse initially:
a.discusses the effects of untreated pain on the patient’s general wellness.
b.offers the patient a prescribed prn analgesic.
c.asks the patient why he is denying the presence of pain.
d.documents the symptoms that the patient is exhibiting.

ANS: A

Older adult patients actually underreport pain and are therefore at risk for undertreatment of pain, which may cause unnecessary suffering, exacerbation of the underlying disease, and reduction in activities of daily living (ADLs) and quality of life. Without this information the patient is unlikely to take the prn medication. “Why” questions are not therapeutic, as they place people on the defensive. The symptoms should be documented, but this should not be the only action.

DIF: Applying (Application) REF: N/A OBJ: 14-2

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. The nurse caring for an older adult patient experiencing carpal tunnel syndrome anticipates the patient will best achieve pain control when prescribed a(n):
a.narcotic (e.g., fentanyl).
b.opioid (e.g., oxycodone).
c.tricyclic antidepressant (e.g., amitriptyline [Elavil]).
d.nonpharmacologic strategy (e.g., wrist bracing).

ANS: C

Neuropathic pain results from a pathophysiologic process involving the peripheral or central nervous system. These types of pain respond to unconventional analgesic drugs, such as tricyclic antidepressants. Carpal tunnel syndrome is caused by nerve injury.

DIF: Analyzing (Analysis) REF: N/A OBJ: 14-8

  1. When planning care for the older adult patient with a history of persistent pain, the nurse acknowledges the effects of the mind-body connection by including:
a.regular pain assessments.
b.prompt response to reports of pain.
c.pain consults.
d.relaxation techniques.

ANS: D

Some mind-body therapies include meditation, relaxation, guided imagery, and cognitive behavioral counseling. The other actions are appropriate but not related to mind-body therapies.

DIF: Remembering (Knowledge) REF: Page 266 OBJ: 14-8

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

  1. An older adult patient has been prescribed an opioid to manage chronic pain resulting from a shoulder injury. To eliminate a common barrier to opioid drug compliance, the nurse:
a.encourages the patient to use the opioid only as prescribed.
b.educates the patient about the appropriate management of constipation.
c.assures the patient that dizziness will decrease as therapeutic levels are reached.
d.suggests the patient take the medication with meals or a snack.

ANS: B

Older adults have a high rate of discontinuation of opiates because of the resulting constipation. The treatment for constipation, especially that which is opioid induced, is readily available and should be provided as a preventive measure before starting narcotic pain medication. The other actions do not address this issue.

DIF: Understanding (Comprehension) REF: Page 263 OBJ: 14-4

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. The nurse is discussing pain control with an older patient who has been prescribed an opiate. When the patient expresses concerns about the diminishing effect that the medication has had on the pain, the nurse responds:
a.“It appears that the dosage you take needs to be adjusted upward.”
b.“We need to be concerned about you developing a drug tolerance.”
c.“This drug category is well known for its low ceiling effect.”
d.“Opiate addiction is a concern when tolerance occurs.”

ANS: A

Tolerance is defined as the diminished effect of a drug while maintaining the same dosage over time. It is a characteristic of opiates when given over time. With opiates, some individuals might need higher and higher doses of a drug to maintain effectiveness. This should not be confused with addiction.

DIF: Understanding (Comprehension) REF: Page 263 OBJ: 14-8

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. An older patient is being treated for arthritic pain with a nonsteroidal anti-inflammatory drug (NSAID). Which question best assesses for side effects of this medication class?
a.“Have you noticed your heart skipping beats since you began taking this drug?”
b.“Did you know you should not to stand up too quickly?”
c.“Are you aware that you should take your pain medication with food?”
d.“Have you had any episodes of shortness of breath since starting this medicine?”

ANS: C

The most common complaint associated with NSAIDs is indigestion. Indigestion may be reduced with antacid use or food consumption timed to coincide with analgesic intake.

DIF: Understanding (Comprehension) REF: Page 263 OBJ: 14-8

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. The nurse is caring for an older adult patient with terminal cancer who is receiving medication via patient-controlled analgesic (PCA) pump. The nurse shows an understanding of primary end-of-life concerns when asking the patient:
a.“Do you have any concerns about receiving your medication intravenously?”
b.“Are you satisfied with the way your pain is being managed?”
c.“Are you worried about becoming addicted to the narcotic analgesics?”
d.“Do you have any questions concerning how to use the PCA properly?”

ANS: B

Terminally ill patients generally identify their main concern as pain control. The other questions do not address this issue.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. The nurse is performing a pain assessment when the older adult patient reports pain in his left shoulder that radiates down into the forearm. The nurse immediately:
a.recognizes that the patient is experiencing cardiac distress.
b.alerts the rapid response team to provide emergency care.
c.asks whether he has ever experienced this pain before.
d.questions the patient about additional related symptoms.

ANS: C

Assessment is essential in differentiating acute life-threatening pain from longstanding chronic pain. Otherwise, disease progression and acute injury may go unrecognized and be attributed to preexisting disease or illness. The patient may or may not be experiencing cardiac ischemia, the rapid response team does not need to be called, and the nurse can assess for other symptoms after determining if this pain is new or not.

DIF: Applying (Application) REF: N/A OBJ: 14-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. An older adult who injured her knee several years ago tells the nurse that she has been managing the resulting intermittent pain with a prescription for propoxyphene (Darvon). The nurse is concerned with this treatment plan, primarily because:
a.less expensive alternative analgesics are available.
b.this long-term need for a narcotic warrants investigation.
c.aspirin would likely be as effective in managing the pain.
d.the knee should not still be causing pain for the patient.

ANS: B

The nurse needs to complete a full assessment to determine what type of pain the patient is experiencing and if a narcotic is the best alternative for the patient. Other medications may be more beneficial.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. The nurse is caring for a 78-year-old with a history of chronic depression. The patient currently reports persistent left shoulder pain since having a fall a year ago. To best address the patient’s pain, the nurse initially determines:
a.if the patient is still at risk for falls.
b.the severity of the shoulder injury.
c.how effectively depression is being managed.
d.the patient’s ability to effectively cope with pain.

ANS: C

Persistent depression affects a person’s ability to cope with the pain, so it must be treated. The nurse should also assess fall risk but that is secondary to determining why the pain has lasted so long and if the patient is able to cope.

DIF: Applying (Application) REF: N/A OBJ: 14-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

  1. Acetaminophen (Tylenol) is prescribed for a 70-year-old with chronic pain. When the patient reports to the nurse that the maximum daily dose of medication does not control the pain, the nurse responds:
a.“Breakthrough pain can be managed with the addition of another analgesic.”
b.“Transcutaneous electrical nerve stimulation (TENS) is often helpful.”
c.“It sounds as though you have developed a tolerance for acetaminophen.”
d.“We will need to get your physician to prescribe another analgesic for you.”

ANS: D

The patient needs a comprehensive review of pain strategies, which will probably include changing pain medication. Using the maximum dose of acetaminophen long term can cause liver damage, which is another reason the patient should switch medications if it is not working.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Communication and Documentation MSC: Physiologic Integrity

  1. An older adult patient is prescribed an analgesic to manage the joint pain resulting from stiffness in his right shoulder. When the patient asks about alternative therapy techniques that might be helpful, the nurse suggests:
a.applying ice packs to the area three to four times a day.
b.placing a moderately warm heating pad to the shoulder.
c.arranging for a professional massage on a weekly basis.
d.discussing electrical nerve stimulation with the physician.

ANS: B

Heat is useful in decreasing pain and discomfort resulting from joint stiffness by increasing the elasticity of muscles. Ice is better for acute exacerbations. Massage may or may not help but would be more expensive. Electrical nerve stimulation is not warranted.

DIF: Understanding (Comprehension) REF: Page 266 OBJ: 14-8

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. The nurse caring for an older cognitively impaired patient with osteoarthritis in both hands assesses the patient for hand pain by:
a.observing for facial grimacing when the patient uses a fork to eat.
b.being alert for signs of agitation when washing the patient’s hands.
c.listening to detect moaning when patient makes a fist.
d.watching for signs that the patient is reluctant to shake hands.

ANS: B

Cognitively impaired patients in pain may not portray any visible signs of pain or distress or may be unable to communicate their pain. Pain may result in agitation, as well as increased pulse, respiration, blood pressure, and confusion. The other options are not as indicative of pain in the cognitively impaired older adult.

DIF: Remembering (Knowledge) REF: Page 258 OBJ: 14-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. A director of nursing in a long-term care facility was concerned after reading that as many as 80% of residents have untreated pain. What action by the director is best?
a.Establish protocols for routine assessment.
b.Make a “pain plan” for every resident.
c.Involve family members in treating pain.
d.Educate the staff on how to assess pain.

ANS: A

Nursing begins with assessment. The director should implement a protocol for routine assessments of pain in both cognitively impaired and intact residents. A “pain plan” cannot be created without this assessment data. Family members should be encouraged to provide input. The staff may or may not need to have education on assessment.

DIF: Applying (Application) REF: N/A OBJ: 14-7

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

  1. An older patient who lives alone is brought to the clinic by an adult child who reports the patient has become “depressed” and no longer wants to go out of the home. What action by the nurse is best?
a.Assess the patient for depression.
b.Ask the patient why activities are avoided.
c.Assess the patient for pain.
d.Assess the patient for elder abuse.

ANS: C

Many older adults have pain that goes untreated. Consequences of untreated pain are numerous and include depression and withdrawal. The nurse should first assess for pain. Assessing for depression or elder abuse may be warranted as well. Asking “why” questions is not therapeutic, as patients tend to become defensive.

DIF: Applying (Application) REF: N/A OBJ: 14-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. A confused patient is admitted to the hospital after suffering a fall. When asked about pain, the patient does not respond. What action by the nurse is best?
a.Ask the patient again using different words.
b.Pantomime what you are asking the patient.
c.Observe the patient’s nonverbal behaviors.
d.Ask the family members if they think the patient has pain.

ANS: C

In some situations, the nurse cannot rely on the patient’s report of pain, so as a second method of assessment, the nurse looks to the patient’s nonverbal behaviors. The nurse should be aware, however, that the lack of specific “pain behaviors” does not indicate a lack of pain. The other options may be helpful for individual patients.

DIF: Applying (Application) REF: N/A OBJ: 14-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. A patient has just had surgery. What pain control strategy is best?
a.Administer prn medications when requested.
b.Give pain medications around the clock at first.
c.Start with nonopioids then progress to opioids.
d.Ask the patient his or her preference for medication.

ANS: B

After surgery the patient is expected to have pain. The best way to control acute pain is through round-the-clock dosing (at least at first) to keep the patient’s pain from getting out of control. The nurse should assess the patient’s preferences, but should assess preferences for pain levels, because the patient may not be experienced in receiving pain medications. Opioids are expected for acute pain from surgery.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

  1. An older patient is hospitalized for the first time. After giving a dose of hydromorphone (Dilaudid), what assessment takes priority?
a.Pain level
b.Nausea
c.Urinary retention
d.Respiratory rate

ANS: D

Respiratory depression is common with opioid analgesics. All assessments are appropriate; however, respiratory assessment takes priority.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

  1. An older adult lives alone at home and is being treated for chronic pain. The home health care nurse notes the adult is disheveled and has dirty dishes piled up in the sink. What action by the nurse is best?
a.Notify adult protective services.
b.Arrange for hospitalization.
c.Assess the patient’s pain.
d.Assess the patient’s cognitive status.

ANS: C

Although all actions might be appropriate depending on circumstances, because the patient is being treated for pain and has a functional decline, the nurse should assess first for unrelieved pain.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. A patient has constipation as a side effect of opioid analgesics. What menu choice indicates the patient understands nutritional therapy for this problem?
a.Scrambled eggs
b.White bread
c.Canned fruit
d.Oatmeal

ANS: D

Constipation can be managed with high fiber and increased water. Oatmeal has the highest fiber content of the four foods listed.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 14-1

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

  1. The nurse is caring for four frail patients with pain. Which patient’s pain medication prescription does the nurse question?
a.The patient taking pentazocine (Talwin)
b.The patient taking acetaminophen (Tylenol)
c.The patient taking ibuprofen (Motrin)
d.The patient taking hydromorphone (Dilaudid)

ANS: A

Talwin should not be used in frail older people because it leads to central nervous system excitement, confusion, and agitation. The other drugs are appropriate choices.

DIF: Applying (Application) REF: N/A OBJ: 14-8

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

MULTIPLE RESPONSE

  1. When planning nursing care for an older adult who is experiencing chronic pain, the nurse includes which of the following interventions? (Select all that apply.)
a.Maintain mobility.
b.Promote autonomy.
c.Manage any chronically painful condition.
d.Provide economical sensitive pain relief.
e.Support the patient’s right to be pain-free.

ANS: A, B, C

Goals for pain management in older adults include control of chronic disease conditions that cause pain, maintenance of mobility and functional status, promotion of maximum independence, and improvement of quality of life.

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Planning

MSC: Physiologic Integrity

Chapter 28: Integumentary Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

  1. The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include:
a.cleaning lesions with a weak hydrogen peroxide solution daily.
b.cleaning the scalp with a low-dose steroidal shampoo.
c.applying hydrocortisone 10% to scalp lesions.
d.applying selenium shampoo to the scalp.

ANS: D

A successful strategy is to wet the hair, apply selenium shampoo, and then proceed with the rest of the bath or shower. The other measures will not be successful.

DIF: Remembering (Knowledge) REF: Page 611 OBJ: 28-3

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. An older adult patient reports simple xerosis with mild pruritus. The nurse educates her on the importance of:
a.applying a lanolin-rich cream and avoiding scratching the areas.
b.taking warm baths and gently rubbing of affected areas with a terrycloth towel.
c.minimizing ingestion of fried foods and use of an antihistamine cream.
d.avoiding bath oils and allowing the skin to air-dry after bathing.

ANS: A

The nurse suggests that the patient apply emollients (e.g., Lubriderm, Moisturel, or Eucerin lotion or cream), which have more lanolin or oily substances than many commercial lotions. Time should be planned to teach the patient and family about etiologic factors and the importance of not scratching. The other options are not helpful and will not decrease the itching.

DIF: Understanding (Comprehension) REF: Page 612 OBJ: 28-3

TOP: Teaching-Learning MSC: Health Promotion

  1. The nurse plans to assess for candidiasis as a priority intervention for a:
a.60-year-old with a history of bacterial pneumonia.
b.72-year-old incontinence of urine and feces.
c.58-year-old with a casted left foot.
d.90-year-old receiving antihypertensives.

ANS: B

Candidiasis is most commonly seen in diaper-clad infants, incontinent patients, and bed-bound individuals and in moisture-prone areas of the body (e.g., skin folds and axillae). The other patients are not as likely to have this disorder as the incontinent patient.

DIF: Understanding (Comprehension) REF: Page 612 OBJ: 28-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture. The priority nursing diagnosis is:
a.impaired skin integrity related to immunologic deficit.
b.self-care deficit related to severe pain and fatigue.
c.risk for infection related to impaired skin integrity.
d.pain related to inadequate pain relief from analgesia.

ANS: C

These vesicles are extremely vulnerable to secondary bacterial infections. The other diagnoses might be appropriate for some patients.

DIF: Applying (Application) REF: N/A OBJ: 28-3

TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity

  1. The presence of which skin assessment finding, if noted on an older adult patient, should cause the nurse to suspect a premalignancy?
a.Numerous small red papules on the chest and back
b.An oozing, rough, reddish macule on the ear
c.An irregularly shaped mole on the face or shoulders
d.Brown, greasy lesions on the neck

ANS: B

Actinic keratosis begins in vascular areas as a reddish macule or papule that has a rough, yellowish brown scale that may itch or cause discomfort. Actinic keratosis may evolve into squamous cell carcinoma (SCC) if not treated, so it should receive prompt attention. Red papules, irregularly shaped moles, and brown greasy lesions are not likely to be precancerous.

DIF: Understanding (Comprehension) REF: Page 615 OBJ: 28-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. An older adult patient has been taught measures to prevent the development of skin cancer. Which statement, if made by the patient, indicates the need for more teaching?
a.“I will certainly miss my vegetable and flower gardening.”
b.“I should buy a sunscreen with an SPF of 15 or higher.”
c.“Now I have a good excuse to wear the straw hat my spouse hates.”
d.“My cool long-sleeved shirts will work just fine while I’m golfing.”

ANS: A

The patient is still able to garden as long as he or she takes appropriate sun precautions. The other statements show good understanding.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 28-4

TOP: Nursing Process: Evaluation MSC: Health Promotion

  1. When assessing the older adult patient’s skin for indications of melanoma, the nurse should inspect for a(n):
a.thick, adherent scale with a soft center.
b.small, inflamed lesion that bleeds easily.
c.irregularly shaped multicolored mole.
d.small, purple, hard nodule beneath the skin surface.

ANS: C

Melanoma’s clinical hallmark is an irregularly shaped nevus (mole), papule, or plaque that has undergone a change, particularly in color. The other options do not display the characteristic signs.

DIF: Remembering (Knowledge) REF: Page 618 OBJ: 28-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. An older adult patient newly diagnosed with peripheral vascular disease (PVD) is being educated on the possibility of developing a foot ulcer. What assessment finding indicates the patient may have an ulcer resulting from this disease?
a.Deep, necrotic, and painless sore
b.Shiny, dry, cyanotic skin surrounding the ulcer
c.Ulcer appears shallow, crusty with warm skin
d.Sore that has dull pain and is oozing

ANS: B

As the disease advances, the extremity develops a cyanotic hue and becomes cool. The skin becomes thin, shiny, and dry and has an associated loss of hair and thickened nails, all of which results from the diminished blood supply. This assessment finding indicates PVD.

DIF: Remembering (Knowledge) REF: Page 619 OBJ: 28-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. An older adult patient has an open, draining wound on the lower medial aspect of the right leg. The skin surrounding the wound is reddish brown with surrounding erythema and edema. Based on this information, the nurse edits the patient’s care plan to include impaired skin integrity:
a.related to altered venous circulation.
b.peripheral related to arterial insufficiency.
c.related to diabetic neuropathy.
d.open wound related to pressure ulcer.

ANS: A

Venous ulcers are usually on the medial aspect of the lower leg, with flat or shallow craters and irregular borders, accompanied by varicosities, liposclerosis (brown ruddy color and thickened skin), and itching. Venous ulcers generate a large amount of exudate and are usually surrounded by erythema and edema. Arterial insufficiency would produce shiny, taut, hairless skin. There is no indication the patient is a diabetic. There is no indication the patient has risks for pressure ulcers.

DIF: Applying (Application) REF: N/A OBJ: 28-5

TOP: Nursing Process: Analysis MSC: Physiologic Integrity

  1. When assessing for squamous cell cancer (SCC), a home health nurse is particularly concerned about a suspicious lesion on the:
a.leg of a 60-year-old Asian female.
b.neck of a 73-year-old Hispanic female.
c.Lower lip of a 70-year-old African American male.
d.back of a 90-year-old Caucasian male.

ANS: C

SCC is skin cancer arising from the epidermis and is found most often on the scalp, outer ears, lower lip, and dorsum of the hands. Approximately 90% of lip lesions can be attributed to squamous cell carcinoma. SCC is more common in men and older adults. SCC is the most common skin cancer in African-Americans.

DIF: Remembering (Knowledge) REF: Page 617 OBJ: 28-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis. The nurse educates the patient to the possibility of developing:
a.alopecia.
b.orange-tinged urine.
c.yellow-brown nails.
d.cherry angiomas.

ANS: C

Changes in the nails occur in approximately 30% of patients and consist of yellow-brown discoloration with pitting, dimpling, separation of the nail plate from the underlying bed (oncolysis), thickening, and crumbling.

DIF: Understanding (Comprehension) REF: Page 610 OBJ: 28-3

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the patient correctly. The nurse is confident the family is capable of effective positioning when it is observed that the patient’s:
a.arms and legs are supported on two pillows.
b.position is changed at least every 2 hours.
c.neck is hyperflexed.
d.elbows rest on the bed.

ANS: B

In the 1950s, Kosiak (1958) found that pressure applied to rabbits’ ears over 2 hours would result in ulceration. Thus, the universal recommendation of turning every 2 hours was established. The other observations do not show the family necessarily understands effective positioning if the patient is not turned.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 28-6

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

  1. An older diabetic patient reports a candidiasis infection. When asked, the patient states all blood sugars have been within the target range. What action by the nurse is best?
a.Facilitate having a hemoglobin A1c drawn.
b.Teach the patient preventive measures.
c.Teach the patient about the side effects of medications.
d.Review the patient’s medication history.

ANS: A

Often candidiasis infections in diabetics indicate hyperglycemia. The patient may or may not be truthful about the blood sugar reports, or the patient may be missing periods of hyperglycemia when testing. The nurse should consult with the provider about checking an A1C. The other options are appropriate as well but do not give information as to the background cause.

DIF: Applying (Application) REF: N/A OBJ: 28-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

  1. An older patient has been treated for a small basal cell carcinoma on the face. What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met?
a.The patient verbalizes relief there is no metastasis.
b.Wound edges are approximated without redness.
c.The patient expresses satisfaction with the cosmetic outcome.
d.The patient relates the need for proper sun protection.

ANS: B

All findings indicate positive resolution of various nursing diagnoses. However, physical diagnoses take priority, so the best response is the one that indicates lack of infection.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 28-4

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

  1. In creating community education on various types of skin cancer, the nurse places the highest priority on early diagnosis of melanoma because:
a.it accounts for the largest number of mortalities.
b.extensive surgery can be avoided if caught early.
c.once it has spread there is no chance of curing it.
d.it is the most commonly occurring skin cancer.

ANS: A

Melanoma only accounts for 5% of skin cancer diagnoses but causes 75% of skin cancer mortality. Therefore, it is critical that the condition is diagnosed promptly.

DIF: Remembering (Knowledge) REF: Page 618 OBJ: 28-4

TOP: Teaching-Learning MSC: Health Promotion

  1. An older diabetic patient has impaired mobility and decreased vision. The nurse examines the patient’s feet at each clinical visit. The patient asks why this is necessary. What response by the nurse is best?
a.“It’s part of our diabetic clinic visit protocol.”
b.“You may not be able to see a sore on your feet.”
c.“Limited mobility may keep you from checking your feet.
d.“You may get an ulcer and not be able to feel it.”

ANS: D

A diabetic with peripheral neuropathy may not be able to feel injuries on the feet. The injury may progress to a nonhealing ulcer requiring amputation. If the patient had good sensation to the feet, not being able to see or limited mobility would not be as big of a barrier because the patient could report the symptoms. Foot assessment is part of a diabetic clinic protocol.

DIF: Analyzing (Analysis) REF: N/A OBJ: 28-5

TOP: Teaching-Learning MSC: Physiologic Integrity

  1. For which patient does the nurse add compression therapy to the nursing care plan?
a.Taut, white, shiny skin
b.Faint pedal pulses
c.Brownish skin and edema
d.Large ulcer with skin graft

ANS: C

Compression is the mainstay of venous ulcer treatment, and it should be applied when there is brownish skin and edema. The taut white shiny skin and faint pulses indicate arterial insufficiency, and compression will compromise circulation in those extremities even further. A skin graft needs to be protected, as it is vulnerable until healed.

DIF: Analyzing (Analysis) REF: N/A OBJ: 28-5

TOP: Nursing Process: Planning MSC: Physiologic Integrity

  1. The nurse assesses a patient using the Braden scale. The patient scores a 13. What action is most important to add to the patient’s care plan?
a.Encourage high-protein meals and snacks
b.Turn the patient every to 2 hours
c.Assess the patient’s skin daily
d.Monitor patient’s prealbumin weekly

ANS: B

A Braden scale score of 13 indicates high risk for developing a pressure ulcer. The most important intervention is to turn the patient frequently. Good nutrition is important for wound healing and prevention, but a high-protein snack and monitoring prealbumin do not immediately impact the patient’s skin condition. Assessing the skin will not prevent an ulcer.

DIF: Applying (Application) REF: N/A OBJ: 28-7

TOP: Nursing Process: Planning MSC: Physiologic Integrity

  1. A patient has a purulent, foul-smelling leg wound. What wound care practice is most appropriate?
a.Leave the wound open to the air.
b.Administer systemic antibiotics.
c.Cleanse the wound with diluted povidone iodine.
d.Prepare the patient for operative débridement.

ANS: C

Antiseptics are not used on healthy granulating tissue. Povidone iodine must be diluted and only used short term. A moist environment is needed for healing; leaving the wound open to air will cause too much drying. The patient may eventually need operative débridement. Systemic antibiotics may or may not be needed.

DIF: Applying (Application) REF: N/A OBJ: 28-10

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

  1. A patient has a wound that is a shallow crater with surrounding erythema and warmth. What stage pressure ulcer does the nurse chart?
a.Stage I
b.Stage II
c.Stage III
d.Stage IV

ANS: B

Stage II is a partial thickness ulcer that looks like an abrasion, blister, or shallow crater. A stage I pressure ulcer is redness or mottled skin that does not blanch. Stage III ulcers are full thickness deep craters. Stage IV ulcers may extend into the fascia and may be necrotic.

DIF: Remembering (Knowledge) REF: Page 630-1 OBJ: 28-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

MULTIPLE RESPONSE

  1. The nurse knows that several age-related changes in the integumentary system increase older adults’ risk for pressure ulcers. Which factors does this include? (Select all that apply.)
a.Poor nutrition
b.Living in a nursing home
c.Thinning epidermis
d.Decreased skin elasticity
e.Vessel degeneration

ANS: C, D, E

Thinning epidermis, decreased elasticity of the skin, and deterioration of the vasculature are all age-related changes increasing risk of pressure ulcer development. Poor nutrition and living in a nursing home are not expected age-related changes.

DIF: Remembering (Knowledge) REF: Page 622-4 OBJ: 28-6 | 28-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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